Violation of the normal perception of the surrounding world and oneself is a pathological condition, which in medicine is classified as depersonalization. Depersonalization is expressed by a painful feeling of change, lack of unity or loss of the most important personality qualities that are acquired in the process of life experience (character, worldview, value system, life attitudes, etc.). Patients with depersonalization feel that their “I” has completely changed, the old “I” has disappeared, they have lost their spiritual world, they have lost their individuality and independence. As a rule, all patients with depersonalization are prone to “soul-searching” and persistent attempts to figure out “what’s wrong with them.”
In simple terms, depersonalization is a state in which a person feels “changed”, “not the same as before”, “lost some important personality properties”. In extreme, most pronounced cases, he “sees” and evaluates himself from the outside. Often the pathological condition under consideration is referred to as depersonalization-derealization, which implies not only a split personality, but also a violation of the perception of the surrounding world - the patient seems to be inside a virtual game, all the objects and living creatures around him have a flat shape or an unreal color.
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Causes of depersonalization
Depersonalization-derealization syndrome is a mental disorder that occurs within the framework of:
- neurotic disorders;
- neurological disorders;
- suffered shock (for example, after a serious injury);
- frequent stress;
- schizophrenia;
- manic syndrome;
- depressive syndrome.
The condition in question can be short-term or long-term, and in the latter case, such a mental disorder often leads to suicide. If the depersonalization-derealization syndrome is short-term, then most likely it is triggered by some kind of nervous shock (death of a loved one, trauma, and so on). The short-term course of the condition in question always ends in complete recovery without any consequences, although this may take several months.
Details about the causes of derealization
Recent studies show that approximately 3% of the world's population show signs of one-time or periodic derealization. According to experts, the reason for the increase in the number of people with this disorder is the increase in the pace of life, urbanization, and increased stress levels.
Let us highlight the main reasons for the development of derealization:
— Lack of realized goals, discrepancy between real living conditions and given ambitions, desires, dreams;
— Accumulation of physical and mental fatigue;
— Drug and alcohol abuse;
— Psychogenic factors: experienced incidents, accidents, death of a loved one;
— Suppression of individuality, moral torture.
By indicating what derealization is, we can talk exclusively about a psychological phenomenon. Only as a result of a negative impact on the psyche can some biological functions be disrupted. For example, the vestibular apparatus or vision (when a person loses the color of the picture, loses orientation in space and feels outside of reality).
Symptoms of depersonalization-derealization syndrome
The clinical picture of depersonalization in some cases is quite vivid - complaints sound characteristic and typical for this disorder, and in some cases it is difficult for the patient to determine and express “what is wrong with him,” and the essence of all his complaints will come down to the painful repetition of the phrase “with me.” something is happening, I don’t feel good, something bad happened to me, I don’t understand.” In a conversation with such patients, it is important to correctly formulate questions and be able to identify that element of mental activity, the perception of which is impaired in the patient.
Doctors consider several symptoms of the syndrome:
- A feeling of altered mental processes is a feeling that the information entering the brain, as it were, “encounters a kind of internal barrier and cannot be assimilated in full,” in other words, there is a feeling of impaired perception of information. Trying to express this, patients say that they are “as if covered with a cap,” “placed in a glass flask,” “separated from the environment by an invisible wall.” This may be a feeling of disruption of one or more mental functions (emotions, thinking or activity) - or even all mental activity, which is accompanied by a feeling of “incompleteness of consciousness” and a subjective disturbance in the perception of one’s memories, ideas that lose brightness, seem pale, indistinct, “unreal”. With pronounced depersonalization, there is a feeling of strong alteration or loss of several mental functions or all mental activity, up to a complete loss of the sense of one’s own existence.
- A feeling of altered perception of bodily sensations - obtained through various senses (vision, hearing, various types of skin and other sensitivity), which are expressed, for example, by a feeling of physical emptiness, numbness, mortification in various parts of the body, in more severe cases there is a feeling of complete absence various organs, body parts, body weight, etc. In especially severe cases, a feeling of complete absence of the body may develop, but at the same time, in contrast to depersonalization of mental functions, the feeling of the mental “I” is always preserved.
- A feeling of changes in the perception of the surrounding space - color, volume, contrast: patients complain that the sounds of the outside world are heard muffled, distant or, on the contrary, deafeningly loud, everything seems too bright or, on the contrary, faded, as if it were a set for a film, as if painted, unreal, fake.
People around you may notice disturbances in a person with depersonalization-derealization syndrome of a mental nature:
- he sits in one place and in one position for a long time, as if he has nothing to do and does not need to go anywhere;
- the patient cannot remember what he likes and what he doesn’t (for example, does he like apples);
- lack of desire to lead an active lifestyle - the patient does not wash things, does not clean the house, does not attend work/school.
Symptoms and clinic of derealization
With derealization, patients have the feeling that reality, objects, and society are not natural, fantastic, alien, while the patient cannot find an explanation for how this happened.
Reality is perceived as if through a dream, as if through glass, an opaque film, or fog. The surroundings can be perceived as scenery. Everything around seems to have no volume, fuzzy, dim, and without perspective.
During attacks of the disorder, the perception of time is distorted. Some patients have the feeling that the processes around them have slowed down and stopped. Other patients, on the contrary, have a feeling of acceleration of time processes, the rapidity of events. In rare cases, the perception of the past, present and future disappears, and everything is perceived as the present.
The most common symptoms of derealization are visual disturbances. The surroundings may be perceived as monochromatic, gray, and blurry. Everything around may resemble a pencil drawing.
In rare cases, the opposite may happen - everything around seems very bright, like cartoons. Visual distortions also occur in “tunnel” vision, when everything except the object in focus blurs together. Also, the world around can be perceived upside down by 180°, or as a mirror image.
Hearing disorders are expressed in the perception of other people's speech as slow, heightened perception of individual sounds, and ringing in the ears. Sounds may be perceived as distant.
With allopsychic depersonalization, disturbances in tactile perception occur: the patient cannot determine by touch the physical parameters of an object (temperature, material, texture).
The distortion of the perception of space is expressed in the fact that the individual cannot assess the distance: the distant seems close, the close seems distant.
Classification of the syndrome
In medicine, it is customary to distinguish several forms of depersonalization-derealization syndrome:
- Autopsychic. The patient becomes immersed in himself, he experiences fear and confusion, because he feels that he has changed, is not the same as before, his feelings and thoughts have changed, they are “spoiled”, “unreal”. This type of disease in question is often characterized by the following behavior: reluctance to communicate with friends and family, an external absence of emotional manifestations, complaints of memory loss (incomplete).
- Allopsychic. It is this type of depersonalization syndrome that doctors call derealization - the patient perceives the surrounding reality as a dream or a game/fairy tale. Characteristic signs of such a disorder will be a lack of understanding of one’s location in familiar places, indifference/complete ignorance when meeting a familiar person, problems recognizing people (sometimes they all seem the same to the patient), and the inability to clearly determine the color and shape of objects.
- Somatopsychic. This form is considered the most unusual because patients present strange complaints - for example, they may feel like they are not wearing clothes, or that each part of their body exists separately, and so on. We can say that the somatopsychic type of depersonalization-derealization syndrome is characterized by a pathological perception of one’s own body.
Diagnostic measures
This syndrome is diagnosed based on the patient’s complaints and information from relatives, which describe human behavior characteristic of this disease. No examinations, collection of tests or instrumental examinations make it possible to identify mental abnormalities of the nature in question; on the contrary, people with progressive depersonalization-derealization syndrome look absolutely healthy.
The diagnosis of depersonalization is made clinically - through conversation or semi-structured interview. All additional examination methods are prescribed only in cases where it is necessary to exclude concomitant pathologies.
Diagnosis and test for the disorder
It is necessary to carry out differential diagnostics to make a diagnosis. This is necessary in order to exclude the presence of more serious psychopathological syndromes. For this, psychotherapists use a survey using the Nuller and Genkina scale.
This derealization test can be taken online and allows you to identify the severity of the disorder, determine whether the patient is aware of the pathology of his perception, and whether he is able to give a critical assessment of his feelings. During the test, the patient is asked questions related to symptoms, and the patient must indicate the extent and frequency of their occurrence. Test results of 30-31 points indicate the presence of the syndrome in the patient.
In addition, the doctor needs to examine the patient, checking his reflexes, skin condition, etc., check for the presence of autonomic disorders, study the medical history of the patient and his family, and prescribe an examination (urine and blood tests, electrocardiogram, electroencephalography, magnetic resonance imaging). It is also necessary to conduct a sensory sensitivity test, which includes checking tactile sensations, reaction to light, visual and auditory perception.
The diagnosis of derealization is made if the patient can critically assess his condition; realizes that the distortion of the surrounding world occurs exclusively in his perception; is in clear consciousness.
General principles of treatment
Depersonalization-derealization syndrome is a mental disorder for which an individual approach is used to treat. If this condition was caused by some kind of nervous shock and is some kind of “protection” of the body after powerful emotional outbursts, then treatment comes down to a course of psychotherapy. After the specialist talks with the patient and assesses his condition, antidepressants and various physiotherapeutic procedures - acupuncture, herbal medicine, soothing massage - can be prescribed. As a rule, with a competent approach to prescriptions, this pathological condition passes without complications, and the patient’s condition is completely restored.
But if the depersonalization-derealization syndrome is protracted and accompanied by suicidal attempts, then such patients need to be treated only in inpatient departments of medical institutions; they are prescribed antipsychotics and tranquilizers in large doses. If such treatment tactics give positive results, and the patient becomes calmer and begins to perceive the world around him in a normal light, then he is prescribed psychotherapy, and all medications are discontinued. Psychotherapists work with such patients for a long time, and even after discharge from a medical institution, they must periodically visit a specialist in order to finally get rid of obsessive, incorrect sensations.
Depersonalization-derealization syndrome is a fairly serious mental disorder that can easily be corrected. If you find these symptoms in yourself or your loved ones, we recommend that you consult a specialist. To clarify the diagnosis and receive qualified medical care, you can contact CELT. This is one of those conditions in the treatment of which our psychoneurologists achieve good results.
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- Saturday: 8.00–18.00
- Sunday is a day off
The nearest metro and MCC stations to the clinic:
- Highway of Enthusiasts or Perovo
- Partisan
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Treatment of derealization-depersonalization syndrome
Treatment of derealization-depersonalization is, first of all, determined by the causes and mechanisms of development of this condition, and begins with a detailed diagnosis.
Diagnosis should include psychological counseling and examination by a psychiatrist. The treatment process itself should include both psychotherapeutic influence and drug therapy.
The choice of psychotherapy methods and the selection of medications depends on many factors and is carried out taking into account the individual parameters of the body’s development.
Psychological consultation.
This will help you understand why derealization and depersonalization manifests itself and will help you gain situational control over your symptoms. Most often, two methods are used in the treatment of derealization-depersonalization: cognitive behavioral therapy and psychodynamic therapy.
